소화기 ; 관상동맥조영술이 정상인 비심인성 흉통 환자의 상부위장관내시경 소견

이명하 ( Myoung Ha Lee ),박영숙 ( Young Sook Park ),김남인 ( Nam In Kim ),정준영 ( Jun Young Jung ),송은주 ( Eun Ju Song ),조윤주 ( Yun Ju Jo ),김성환 ( Seong Hwan Kim ),전대원 ( Dae Won Jun ),최재웅 ( Jae Ung Choe ),유승기 ( Seun 대한내과학회 2009 대한내과학회지 Vol.77 No.2

목적: NCCP의 정의, 원인 등이 매우 모호하고 광범위한 상태에서 식도 질환에만 주로 초점이 맞춰진 것은 서구에서 식도 질환의 높은 빈도 때문이다. 그러나 인접한 중국, 일본 등에서 NCCP의 원인으로 GERD의 빈도는 서구에 비해 낮고, 소화성 궤양의 경우는 서구보다 높게 보고하였다. 따라서 저자들도 우리나라에서 NCCP의 원인으로 GERD 외에 위십이지장 질환의 빈도를 알아보고자 이번 연구를 진행하였다. 방법: 2004년 1월부터 2008월 1월까지 본원에서 관상동맥 조영술로 심인성 원인이 배제된 NCCP 환자 중 추가로 상부위장관 내시경 검사를 시행한 89명 환자들의 의무기록을 후향적으로 검토하여 식도, 위십이지장 질환을 분석하였다. 결과: 89예의 내시경 검사결과에서 GERD는 18예(20.2%)였고, GERD의 정도는 미세변화가 9예, LA 분류 group A가 3예, group B가 4예, group C가 2예였다. 위궤양은 13예(14.6%), 십이지장 궤양은 3예(3.3%)였고, 그 외 미란성 위염 17예(19.1%), 발적성 위염 12예(13.5%), 위축성 위염 21예(23.6%)였으며 정상 2예(2%), 위암, 위 점막하종양, 위용종이 각각 1예씩(1%) 관찰되었다. 소화성 궤양으로 진단된 16예 중 조직 검사나 CLO test를 시행한 환자는 11예(68.7%)였으며 그 중 H. pylori 양성은 6예(54%), 음성은 5예(46%)였다. 결론: 국내의 경우 H. pyroli 감염률이 높고 소화성 궤양의 빈도가 높으며 상대적으로 GERD의 빈도가 서구에 비해 낮다. 이런 비율은 NCCP 환자에도 적용될 수 있으며 이번 연구에서도 NCCP의 원인으로 소화성 궤양의 비율은 17.9%로 20.2%인 GERD의 비율과 유사하였다. 결국 우리나라에서 소화성 궤양은 GERD와 같이 NCCP의 중요한 원인임을 알 수 있으며 소화성 궤양의 경우 H. pyroli 제균의 필요성, PPI 투약기간의 차이점이 있기 때문에 예후의 향상을 위해선 상부위장관 내시경 검사로 소화성 궤양과 GERD를 감별하려는 노력이 필요하겠다. Background/Aims: Noncardiac chest pain (NCCP) mainly results from esophageal lesions in the developed world. By contrast, gastroesophageal reflux disease (GERD) is a less frequent cause of NCCP than peptic ulcer disease in China and Japan. Therefore, both esophageal lesions and stomach and duodenal lesions are likely to be important causes of NCCP in Korea. We used upper gastrointestinal endoscopy to evaluate lesions of the esophagus, stomach, and duodenum in NCCP patients after cardiac chest pain was ruled out by coronary angiography (CAG). Methods: From the patients who underwent CAG between 2004 and 2008, we identified 89 patients who had normal CAG or minimal disease. We retrospectively analyzed the endoscopic findings of these 89 patients who were diagnosed with NCCP. Results: At endoscopy for the 89 patients, the percentages of GERD, gastric ulcer, and duodenal ulcer were 20.2% (n=18), 14.6% (n=13), and 3.3% (n=3) respectively. Of the 16 cases diagnosed as peptic ulcer, 11 were evaluated by biopsy or the Campylobacter-like organism (CLO) test for suspected Helicobacter pylori infection. Six (54%) cases were positive for H. pylori and five (46%) were negative. Conclusions: In Korea, the incidence of peptic ulcer disease (17.9%) as a cause of NCCP is similar to that of GERD (20.2%). Consequently, we should perform endoscopy to determine the cause of NCCP. (Korean J 77:187-192, 2009)

증례 : 신장 ; 과음 후 발생한 자발성 방광파열 1예

이명하 ( Myoung Ha Lee ),정준영 ( Jun Young Jung ),백대현 ( Dea Hyun Beak ),박영숙 ( Young Sook Park ),유탁근 ( Tag Keun Yoo ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ) 대한내과학회 2009 대한내과학회지 Vol.76 No.3

자연 방광파열은 매우 드물지만 조기에 진단하지 못하면 치명적인 합병증을 유발할 수 있으므로 알코올 섭취의 병력과 복통, 원인 불명의 복수, 핍뇨성 신부전의 양상을 보이는 환자에서 방광파열도 감별진단에 포함하여 복수 크레아티닌 검사를 시행하고 의심이 되면 확진 및 수술로 예후의 향상을 가져올 수 있겠다. Spontaneous urinary bladder rupture is uncommon, but is associated with significant morbidity and mortality because of delayed diagnosis. A 65-year-old man was admitted to the emergency room because of low abdominal pain and abdominal distention of sudden onset. The previous night, he had consumed a bottle of alcohol and fallen asleep. Diagnosed as peritonitis of unknown origin, he was prescribed antibiotics empirically. However, the ascites progressed and oliguric acute renal failure developed. On the fifth day, we measured the creatinine level in the ascitic fluid and performed retrograde cystography. He was diagnosed as idiopathic spontaneous bladder rupture and underwent a primary repair successfully. When a patient presents with acute abdominal pain, ascites, and oliguric acute renal failure without definite causes, physicians should consider idiopathic spontaneous bladder rupture, measure the creatinine level in the ascitic fluid immediately, and perform retrograde cystography to obtain an early diagnosis. (Korean J Med 76:370-373, 2009)

사업장에 적용 가능한 감염병(COVID-19) 위험성평가 지표 개발

김하경,이명하,송형준,Kim, Ha Kyeong,Lee, Myoung Ha,Song, Hyung-Jun 한국안전학회 2022 한국안전학회지 Vol.37 No.2

Widespread infectious diseases are a concern for workers working in confined spaces. However, there is no risk assessment index for the risk of infectious disease in the workplace. Therefore, we propose a simple but effective index model to assess the risk of infectious diseases in the workplace. The proposed model identifies the risk of each workplace through an evaluation sheet comprising the frequency and intensity of the infectious disease. The intensity of an infectious disease is generally governed by the density of workers, whereas frequency is the sum of physical-e nvironmental and human management factors. By multiplying intensity and frequency, the risk of the workplace is derived. Through the proposed model, we evaluate the risks of workers at 15 different work sites. The proposed model clearly reveals what should be improved to keep workers safe from infectious diseases and will be helpful in assessing the risk of contagious disease at the work place.

종례 : 간 종괴로 오인된 우측 심부전에 의한 간 울혈 1예

신동호 ( Dong Ho Shin ),이명하 ( Myoung Ha Lee ),김도영 ( Do Young Kim ),이경주 ( Kyong Joo Lee ),박준용 ( Jun Yong Park ),안상훈 ( Sang Hoon Ahn ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ) 대한소화기학회 2010 대한소화기학회지 Vol.56 No.4

This report describes a patient with hepatic congestion due to right heart failure mimicking liver tumor. The patient had a history of breast cancer and left total mastectomy 30 years ago, tricuspid valve regurgitation and tricuspid valve replacement 4 years ago. Three years ago, abdominal contrast-enhanced computed tomography (CT) was performed to evaluate inguinal hernia, which revealed multiple small hepatic nodules. After 1 year, the number and size of liver nodules were increased in CT scan. The patient underwent gun biopsy and histopathology revealed sinusoid enlargement. The patient recently had jaundice, abdominal distension, and peripheral edema. Liver dynamic CT scan was done to evaluate the palpable liver. The number and size of liver nodules were more increased in CT than 2 years ago. In magnetic resonance imaging (MRI), numerous variable sized ill-defined nodules replacing entire liver with progressing centripetal enhancement, which were suggestive of malignancy such as angiosarcoma, were noted. MRI finding suspects malignancy or hemangiosarcoma. Finally, the patient received repeated gun biopsy, and histopathology revealed findings compatible with hepatic congestion. (Korean J Gastroenterol 2010;56:264-267)

간세포암종의 치료법

김도영 ( Do Young Kim ),이명하 ( Myoung Ha Lee ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.3(S)

혈액투석 중인 류마티스관절염 환자에서 Etanercept (Enbrel(R))로 치료한

백대현 ( Dae Hyun Baek ),송은주 ( Eun Ju Song ),이명하 ( Myoung Ha Lee ),이상렬 ( Sang Ryul Lee ),성수아 ( Su Ah Sung ),황영환 ( Young Hwan Hwang ),허진욱 ( Jin Wuk Hur ) 대한류마티스학회 2008 대한류마티스학회지 Vol.15 No.4

Disease-modifying antirheumatic drugs (DMARDs) have been used for rheumatoid arthritis (RA) with the aim of controlling synovitis and reducing radiologic progression. Although methotrexate (MTX) is one of the most effective DMARDs, it may cause severe adverse effects. Especially, hematologic toxicity including leukopenia, thrombocytopenia, and fatal pancytopenia is reported in patients with impaired renal function, since renal excretion constitutes the major route of MTX elimination. Tumor necrosis factor-α (TNFα) inhibitors are well-established biologic agents for the treatment of RA and their clinical efficacy and safety are already demonstrated. But there were few reports on the efficacy and safety in dialysis patients. We described a case of hemodialysis patient with refractory RA that was successfully treated with etanercept, and discussed with literature review.